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RGV Harley-Davidson RENTAL APPLICATION
 

ADDITIONAL INSURANCE OPTIONS

 

SUPPLEMENTAL LIABILITY INSURANCE

 By my initials, I accept or decline enrollment for Supplemental Liability Insurance. If I accept, I understand and acknowledge that coverage is at the rates indicated and that I have read the certificate of insurance furnished by the Rental Operator prior to rental.

Accept Decline


PERSONAL ACCIDENT & PROPERTY

 By my initials, I accept or decline enrollment for Personal Accident Insurance and Personal Property Insurance. If I accept, I understand and acknowledge that coverage is at the rates indicated and that I have read the certificate of insurance furnished by the Rental Operator prior to rental.

  Accept Decline


LOSS DAMAGE WAIVER

By my initials, I accept or decline Loss Damage Waiver. If I accept, I understand and acknowledge the waiver is at the rates indicated on the Loss Damage Waiver form.

Accept Decline


PLEASE NOTE: Insurance coverage does not apply when the Motorcycle is operated by persons other than the Renter or if the Renter operates the Motorcycle while under the influence of drugs or alcohol and Renter will be personally responsible for all claims and damages resulting from such operation.

 
 Expected Rental Date:        
 Expected Return Date:        
   

 Renter (Last, First, M)  

 

DOB   

(mm/dd/yyyy) 

     
 Street    
City, State and Zip    
Country  
   
Home Phone    
Work Phone    

E-Mail Address  

 

  

 
 License #     
 State Issued    
Expiration Date        
   
   

 Additional Renter (Last, First, M)  

 

DOB

(mm/dd/yyyy)

       
Street    
City, State and Zip    
 Phone    

 E-Mail Address:

 
 
 License #    
 State Issued    
Expiration Date        
 

TERMS AND CONDITIONS The terms, "Renter," "I," "me," and "my" refer to the person who signs this Agreement as renter and any additional renter listed above, all of whom are jointly and severally liable for the charges and obligations set forth in this Agreement. The terms, "you" and "your" refer to RGV Harley-Davidson.  The term, "Motorcycle," means the Motorcycle specified above, or its replacement, including all tires, tools, Motorcycle documents, accessories, equipment and plates.

 

 I AGREE TO ALL TERMS AND CONDITIONS 
 

   

 

 
 

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